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General NPI Number Information
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NPI Number | 1801558143
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Entity Type | Organization
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Legal Business Name | ON BALANCE PHYSICAL THERAPY, WELLNESS AND COACHING, LLC
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 5731 BALTIMORE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19143-2723
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Country | US
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Telephone | 484-489-0166
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Fax |
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Provider Business Mailing Address
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Address Line | 5731 BALTIMORE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19143-2723
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | SUSSI VOAK
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Credential | PT
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Telephone | 484-489-0166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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